Provider Demographics
NPI:1962625335
Name:LAKE OSWEGO COUNSELING CENTER
Entity type:Organization
Organization Name:LAKE OSWEGO COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CARI
Authorized Official - Last Name:ESTERGARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-675-2830
Mailing Address - Street 1:9 MONROE PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8866
Mailing Address - Country:US
Mailing Address - Phone:503-675-2830
Mailing Address - Fax:503-675-2852
Practice Address - Street 1:9 MONROE PKWY STE 270
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8866
Practice Address - Country:US
Practice Address - Phone:503-675-2830
Practice Address - Fax:503-675-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2106103TC0700X, 103TC0700X
ORL35791041C0700X
ORL30551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1285874933OtherRENDERING NPI
OR1285851154OtherRENDERING NPI
OR1386979946OtherRENDERING NPI
OR1134342587OtherINDIVIDUAL NPI
ORR138283Medicare PIN
ORR155288Medicare PIN
OR1134342587OtherINDIVIDUAL NPI
OR1285851154OtherRENDERING NPI
OR1386979946OtherRENDERING NPI
ORR145292Medicare PIN